Diluted porcine surfactant lung lavages in children with severe ARDS

Acute respiratory distress syndrome (ARDS) is characterized by damage to the arteriolar-capillary endothelium and alveolar epithelium that leads to surfactant deficiency and atelectasis. Alveolar collapse and pulmonary edema will further induce surfactant inactivation. Surfactant supplementation has been suggested but results are unpredictable. Poor response may be due to inhibition of administered surfactant by plasma components filling the alveolar space, severity of lung injury, time of surfactant application and inadequate dose. We report the course of gas exchange and pulmonary mechanics after instillation of surfactant in 14 children (3 months-7 years) with severe ARDS, defined as an oxygenation index (OI) > 30 and a partial pressure of oxygen/ fraction of Inspired oxygen (PaO2/FiO2) <150 . We used a diluted concentration of Curosurf (8 mg/ml) divided into 4 aliquots, for a total dose of 25 mg/kg. An additional aliquot was used for bronchoalveolar lavage before surfactant treatment. All children showed a dramatic response to surfactant with rapid and progressive increase in compliance and improvement of all respiratory mechanics. Mechanical ventilation settings were rapidly reduced and gas exchange improved with a PaO2/FiO2 >200 for more than 12 hours. Diluted surfactant lung lavages were able to increase blood gas exchange in all our patients despite previously severe gas exchange impairment

Diluted porcine surfactant lung lavages in children with severe ARDS

Acute respiratory distress syndrome (ARDS) is characterized by damage to the arteriolar-capillary endothelium and alveolar epithelium that leads to surfactant deficiency and atelectasis. Alveolar collapse and pulmonary edema will further induce surfactant inactivation. Surfactant supplementation has been suggested but results are unpredictable. Poor response may be due to inhibition of administered surfactant by plasma components filling the alveolar space, severity of lung injury, time of surfactant application and inadequate dose. We report the course of gas exchange and pulmonary mechanics after instillation of surfactant in 14 children (3 months-7 years) with severe ARDS, defined as an oxygenation index (OI) > 30 and a partial pressure of oxygen/ fraction of Inspired oxygen (PaO2/FiO2) <150 . We used a diluted concentration of Curosurf (8 mg/ml) divided into 4 aliquots, for a total dose of 25 mg/kg. An additional aliquot was used for bronchoalveolar lavage before surfactant treatment. All children showed a dramatic response to surfactant with rapid and progressive increase in compliance and improvement of all respiratory mechanics. Mechanical ventilation settings were rapidly reduced and gas exchange improved with a PaO2/FiO2 >200 for more than 12 hours. Diluted surfactant lung lavages were able to increase blood gas exchange in all our patients despite previously severe gas exchange impairment

“Spontaneous” ping-pong fracture in newborns: case report and review of the literature

“Ping-pong” fractures (PPF) are depressed skull fractures typical of newborns. PPF usually result from head injury and, rarely, may cause severe long-term neurological sequelae. The management of PPF is still controversial. The goal of this paper is to present a case of “spontaneous” ping-pong fracture and to review the pertinent literature of the last 20 years. We report on a newborn who presented with a “spontaneous” parietal depressed skull fracture at birth. Preoperative computed tomography (CT) scan confirmed the PPF and excluded brain injuries. Neurosurgical intervention was performed on day 3 with immediate lifting of the fracture; the postoperative course was uneventful. During the last 20 years, 22 cases of “spontaneous ping-pong” fractures in newborn have been reported, with different clinical pictures and management but, generally, with a good outcome. “Ping-pong” fractures can occur in uneventful pregnancies and after uncomplicated vaginal or cesarean deliveries. CT scan, with low-dose protocol for infants, is the gold standard examination to evaluate the fracture and any associated brain lesions. Treatment is selected according to fracture characteristics

Chest wall TB and low 25-hidroxy-vitamin D levels in a 15-month-old girl

Parietal chest wall tuberculosis is an extremely rare manifestation of tuberculosis (TB) in children. We present the case of a 15 month-old girl presenting with a chest wall lesion initially thought to be of neoplastic origin and eventually diagnosed as chest wall TB, which was treated with surgical debridement and specific antitubercular therapy. The girl had not-measurable 25-hidroxy-vitamin D levels, an increasingly recognized risk factor for the development of active TB. To our knowledge, in the English literature there are no similar described cases in such young infants. This case highlight the possibility of dealing with TB and its different manifestations also in low TB burden countries, due to continuously increasing migration flows. A detailed history is a key point to reach the diagnosis. Moreover, our case confirm the possible non casual relationship between TB and low 25-hidroxy-vitamin D levels, pointing out the importance of measuring its levels in all TB patients and considering its supplementation in addition to specific antitubercular therapy

E-SCM and inventory management: a study of multiple cases in a segment of the department store chain

Inventory management through the supply chains is a theme that has always enticed managers throughout the world. Due to the increase in market competitiveness and complexity, the traditional statistical models of forecasting demand, based on time series, no longer met the needs imposed on businesses to maintain adequate levels of their inventory and supply interruptions. With the intent to meet these market demands, ERP systems appeared in the 1990's. Nevertheless, even if allowing for a more adequate level of inventory and supply interruptions achieved mainly by the optimization of internal processes and the reduction in lead time, ERP systems did not contribute to reach the SCM's desired levels of inventory that were aimed at by the more competitive businesses. This is because ERP limits itself to an internal analysis of the business. By contrast, inventory management depends on the consumption information (which is external to the business). Aiming to improve even further the level of services delivered to the end consumer, new solutions have been developed, among them the e-SCM, which, since it makes consumption information available in real time, ends up being more dynamic and efficient than the traditional demand forecasting models, Therefore, the present study aims to analyze how the e-SCM can collaborate in maintaining adequate levels of inventory and interruptions in the supply chains. The hypothesis made is that the traditional statistical forecasting models, based on time series and isolatedly, are no longer adequate to adjust the demand, as the tools based on these models do not update the demand in real time and this is fundamental in the current business dynamics. The research method used was the study of multiple cases in a segment of a chain involving a large retailer, its Distribution Center and a supplier of home appliances. For the analysis of the data, the content analysis technique was used. As main results, it was observed that, after the integration of the chain segment by the e-SCM, there was a reduction in the level of the inventory (36.8% in retail and 18% in the industry) and in inventory turnover (from 18.3 to 5.1 days in retail and from 19.6 to 3.2 days in the Distribution Center), aside from the variation in the interruption (from 17.3% to 2.6% in retail and from 3% to 0.1% in the case of the Distribution Center). Therefore, the study brings forth strong indication that the integration of the chain through the e-SCM, may contribute to the SCM's competitiveness.A gestão dos estoques ao longo da cadeia de suprimentos é um tema que sempre instigou gestores por todo o mundo. Com o aumento da competitividade e da complexidade dos mercados, os tradicionais modelos estatísticos de previsão da demanda, fundamentados em séries temporais, não mais atendiam as necessidades impostas às empresas na adequação de seus níveis de estoques e ruptura. No intuito de atender essas exigências do mercado surgem, nos anos 1990, os sistemas ERP. Entretanto, mesmo possibilitando uma adequação nos estoques e na ruptura, levado principalmente pela otimização dos processos internos e redução do lead time, os ERP não contribuíram para que o SCM atingisse o nível de estoque almejado pelas empresas mais competitivas. Isso porque o ERP limita-se a análise interna da empresa. Já a gestão dos estoques depende de informações de consumo (que são externas a empresa). Buscando-se melhorar ainda mais os níveis de serviços prestados ao consumidor final, novas soluções foram desenvolvidas, dentre elas, o e-SCM que por disponibilizar a informação do consumo em tempo real, acaba sendo mais dinâmico e eficiente que os modelos tradicionais de previsão da demanda. Dessa forma, o presente estudo objetiva analisar como o e-SCM pode colaborar para a adequação dos níveis de estoques e ruptura das cadeias de abastecimento. A hipótese defendida é a de que os modelos estatísticos tradicionais de previsão, baseados em séries temporais, isoladamente não são mais adequados para o ajuste da demanda, tendo em vista que ferramentas baseadas nestes modelos não atualizam a demanda em tempo real e isso é fundamental para a atual dinâmica empresarial. O método de pesquisa utilizado foi o estudo de múltiplos casos em um segmento de cadeia que envolve um grande varejista, seu CD e um fornecedor de linha branca. Para análise dos dados, foi utilizada a técnica de análise de conteúdo. Como principais resultados observou-se que, após a integração do segmento de cadeia pelo e-SCM, houve uma redução no nível dos estoques (36,8% no varejo e 18% na indústria) e no giro (de 18,3 para 5,1 dias no varejo e de 19,6 para 3,2 dias no CD), além da variação da ruptura (de 17,3% para 2,6% no varejo e de 3% para 0,1% no caso do CD). Sendo assim, o estudo traz fortes indícios de que a integração da cadeia, por meio do e-SCM, pode colaborar para o aumento da competitividade da SCM

Increased levels of neurotrophins in the cerebrospinal fluid of children with Epstein–Barr virus meningoencephalitis

SummaryObjectiveThe aim of this study was to evaluate the expression of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in the cerebrospinal fluid (CSF) of children with Epstein–Barr virus (EBV)-induced meningoencephalitis (ME) in order to establish a possible correlation with laboratory findings and neurological manifestations.MethodsA prospective observational clinical study was performed on 10 children with viral ME, five of them with EBV-induced ME. As controls, we used CSF samples collected from children admitted with febrile seizures. Neurotrophin levels were measured using an enzyme immunoassay.ResultsSignificantly higher levels of BDNF and NGF were detected in all patients with viral ME compared to controls. Moreover, in patients with EBV-induced ME, the neurotrophin levels were higher than in those with other viral ME. Of note, in children with EBV-induced ME, we found a significant correlation between neurotrophic factor levels and the number of lymphocytes in the CSF (p<0.001). In these patients we also found a significant correlation between BDNF expression and the blood platelet count (p<0.001). Interestingly, two patients with EBV-induced ME showed a correlation between neurotrophin increase and persistent brain abnormalities, such as prolonged alteration of mental status, psychomotor agitation, and athetosis.ConclusionsViral ME induces an early and strong increased biosynthesis of neurotrophic factors. This neurotrophin over-expression is likely to play a key role in the mechanisms of neuronal inflammation and in the severity of brain damage, particularly in EBV-induced ME

O e-SCM e a gestão dos estoques: um estudo de múltiplos casos em um segmento de cadeia de lojas de departamento

Inventory management through the supply chains is a theme that has always enticed managers throughout the world. Due to the increase in market competitiveness and complexity, the traditional statistical models of forecasting demand, based on time series, no longer met the needs imposed on businesses to maintain adequate levels of their inventory and supply interruptions. With the intent to meet these market demands, ERP systems appeared in the 1990's. Nevertheless, even if allowing for a more adequate level of inventory and supply interruptions achieved mainly by the optimization of internal processes and the reduction in lead time, ERP systems did not contribute to reach the SCM's desired levels of inventory that were aimed at by the more competitive businesses. This is because ERP limits itself to an internal analysis of the business. By contrast, inventory management depends on the consumption information (which is external to the business). Aiming to improve even further the level of services delivered to the end consumer, new solutions have been developed, among them the e-SCM, which, since it makes consumption information available in real time, ends up being more dynamic and efficient than the traditional demand forecasting models, Therefore, the present study aims to analyze how the e-SCM can collaborate in maintaining adequate levels of inventory and interruptions in the supply chains. The hypothesis made is that the traditional statistical forecasting models, based on time series and isolatedly, are no longer adequate to adjust the demand, as the tools based on these models do not update the demand in real time and this is fundamental in the current business dynamics. The research method used was the study of multiple cases in a segment of a chain involving a large retailer, its Distribution Center and a supplier of home appliances. For the analysis of the data, the content analysis technique was used. As main results, it was observed that, after the integration of the chain segment by the e-SCM, there was a reduction in the level of the inventory (36.8% in retail and 18% in the industry) and in inventory turnover (from 18.3 to 5.1 days in retail and from 19.6 to 3.2 days in the Distribution Center), aside from the variation in the interruption (from 17.3% to 2.6% in retail and from 3% to 0.1% in the case of the Distribution Center). Therefore, the study brings forth strong indication that the integration of the chain through the e-SCM, may contribute to the SCM's competitiveness.A gestão dos estoques ao longo da cadeia de suprimentos é um tema que sempre instigou gestores por todo o mundo. Com o aumento da competitividade e da complexidade dos mercados, os tradicionais modelos estatísticos de previsão da demanda, fundamentados em séries temporais, não mais atendiam as necessidades impostas às empresas na adequação de seus níveis de estoques e ruptura. No intuito de atender essas exigências do mercado surgem, nos anos 1990, os sistemas ERP. Entretanto, mesmo possibilitando uma adequação nos estoques e na ruptura, levado principalmente pela otimização dos processos internos e redução do lead time, os ERP não contribuíram para que o SCM atingisse o nível de estoque almejado pelas empresas mais competitivas. Isso porque o ERP limita-se a análise interna da empresa. Já a gestão dos estoques depende de informações de consumo (que são externas a empresa). Buscando-se melhorar ainda mais os níveis de serviços prestados ao consumidor final, novas soluções foram desenvolvidas, dentre elas, o e-SCM que por disponibilizar a informação do consumo em tempo real, acaba sendo mais dinâmico e eficiente que os modelos tradicionais de previsão da demanda. Dessa forma, o presente estudo objetiva analisar como o e-SCM pode colaborar para a adequação dos níveis de estoques e ruptura das cadeias de abastecimento. A hipótese defendida é a de que os modelos estatísticos tradicionais de previsão, baseados em séries temporais, isoladamente não são mais adequados para o ajuste da demanda, tendo em vista que ferramentas baseadas nestes modelos não atualizam a demanda em tempo real e isso é fundamental para a atual dinâmica empresarial. O método de pesquisa utilizado foi o estudo de múltiplos casos em um segmento de cadeia que envolve um grande varejista, seu CD e um fornecedor de linha branca. Para análise dos dados, foi utilizada a técnica de análise de conteúdo. Como principais resultados observou-se que, após a integração do segmento de cadeia pelo e-SCM, houve uma redução no nível dos estoques (36,8% no varejo e 18% na indústria) e no giro (de 18,3 para 5,1 dias no varejo e de 19,6 para 3,2 dias no CD), além da variação da ruptura (de 17,3% para 2,6% no varejo e de 3% para 0,1% no caso do CD). Sendo assim, o estudo traz fortes indícios de que a integração da cadeia, por meio do e-SCM, pode colaborar para o aumento da competitividade da SCM

Interleukin and neurotrophin up-regulation correlates with severity of H1N1 infection in children: a case–control study

Summary Objective To evaluate the correlation between cytokine and neurotrophin expression and clinical findings, disease severity, and outcome of children with H1N1 influenza infection. Methods A prospective observational clinical study was performed on 15 children with H1N1 infection, 15 controls with lower respiratory tract infections (LRTI), and 15 non-infected children. Plasma levels of interleukin (IL)-1β, IL-6, and neurotrophic factor (nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), and glial derived neurotrophic factor (GDNF)) were measured using immunoenzymatic assays. Results Significantly higher levels of IL-1β, IL-6, BDNF, and NGF were detected in patients with H1N1 infection compared to LRTI controls, while there was no significant variation in GDNF in the two groups. IL-1β, IL-6, BDNF, and NGF levels were significantly higher in H1N1 patients with more severe clinical manifestations compared to H1N1 patients with mild clinical manifestations. Of note, IL-6 was significantly correlated with the severity of respiratory compromise and fever, while NGF up-regulation was associated with the duration of cough. No correlation was found between interleukin and neurotrophic factor expression and outcome. Conclusions H1N1 infection induces an early and significant IL-1β, IL-6, BDNF, and NGF up-regulation. The over-expression of these molecular markers is likely to play a neuroimmunomodulatory role in H1N1 infection and may contribute to airway inflammation and bronchial hyper-reactivity in infected children

Effect of Limosilactobacillus reuteri LRE02-Lacticaseibacillus rhamnosus LR04 Combination on Antibiotic-Associated Diarrhea in a Pediatric Population: A National Survey

Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) through the normalization of an unbalanced gastrointestinal flora. The objective of this study was to evaluate the benefits of a probiotic combination (Limosilactibacillus reuteri LRE02-DSM 23878 and Lacticaseibacillus rhamnosus LR04-DSM 16605) on the prevention of AAD in an outpatient pediatric setting. Questionnaires were delivered to pediatricians by each patient/parent during the visits after antibiotics and probiotics treatment to monitor physiological parameters. The primary outcome of both groups (probiotics and no probiotics treated) was the evaluation of the prevalence of AAD between the two groups. Evaluation of stool consistency using the Bristol Stool Scale (BSS) score was performed, as well as the evaluation of AAD duration, frequencies of daily evacuation, and the beginning of diarrhea and weight loss during AAD in both groups and related to antibiotic categories. Results indicated that probiotics, at the recommended dosage of 1.2 × 109 CFU (Colony Forming Unit) per day for 30 days, are associated with lower rates of AAD and a decreased number of days with diarrhea, independent of the type of antibiotic used. Moreover, the use of probiotics resulted in a normal stool consistency in a shorter time period, as evaluated by the BSS

Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department

AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually. METHODS: We carried out a multicentre randomised controlled trial in three children's hospitals in Italy between March 2015 and June 2017. Children from four to 18 years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10. The children were randomised to receive ketorolac 0.5 mg/kg (n = 70) or tramadol 2 mg/kg (n = 70) sublingually or a melt in the mouth powder of 20 mg/kg paracetamol (n = 70). The main study outcome was the pain scores for the three drugs after two hours. RESULTS: The 210 children (58.6% girls) had a median age of 12 years with an interquartile range of 9-14.3. The median pain scores at two hours were not significantly different between ketorolac 2.0 (interquartile ranges, IQR 0.0-4.3) and tramadol 3.0 (IQR 1.0-5.0) vs paracetamol 3.0 (IQR 0.8-5.0). The median pain reductions were all 5.0 points. CONCLUSION: Delivering analgesia sublingually was a suitable option for pain relief in children with acute abdominal pain in the emergency department